HomeMy WebLinkAbout160 Birch Hill Drive (9) DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT RN, #4
Application is hereby. TOWN of SOUTH WINDSOR q
BUILDING DEPARTMENT Blda Pe it
APPROVE 1540 SULLIVAN AVENUE •
*CfR,� 644-2511 ext. 230
Date Building Inspector Application must be printed or typed
Location of job
0 &, A e� - (err(w (*#a)
Street No. Street Lot No.
F
FEE SCHEDULE Floor Apt.No.
$0 - $1,000 - $12.00
Over $1,000
$12.00 per$1,000
or any fraction thereof OWNER iLa
ADDRESS
OWNERS PHONE#
APPLICANT
.0t0 N 8,e 4 ADDRESS
4(
K.
ESTIMATED COST $ 2 L
IS THIS A CONTRACT COST?
YES NO
4j a;2
FEE ENCLOSED $
OR-CQ TYPE OF JOB:
Original Installation
--Alteration/Addition/Repair
Raised 11/95
APPLICATION FOR HVAC PERMIT(Continued from reverse side)
TYPE OF SYSTEM TYPE OF BUILDING
HEATING � RESIDENTIAL �
A/C COMMERCIAL
VENTILATION INDUSTRIAL
HEATING
STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
HYDRONIC— WARM AIR UNIT RADIANT HEATER
EXISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION
DESIGN TEMP. OUTSIDE F INSIDE F DIFFERENCE F
TOTAL HEAT LOSS(BTUH)
(HEAT LOSS SHEET MUST ACCOMPANY APPLICATION)
DESCRIBE ALL HEATING EQUIPMENT (INCLUDING MAKE&MODEL NO.)
GROSS HEATING CAPACITY (INPUT-BTUH) NET RATING (OUTPUT-BTUH),.�&_/
TYPE OF FUEL
OIL-GPM GAS-INPUT ELECTRIC-KW
OIL TANK SIZE&LOCATION
INSIDE OUTSIDE CAPACITY LPG TANK CAPACITY
AIR CONDITIONING
DESIGN TEMP. OUTSIDE F INSIDE F DIFFERENCE F
TOTAL HEAT GAIN(BTUH)
(HEAT GAIN SHEET MUST ACCOMPANY APPLICATION)
DESCRIBE ALL COOLING EQUIPMENT (INCLUDING MAKE&MODEL NO.)
TONNAGE COOLING CAPACITY(BTUH)
VENTILATION
DESCRIBE ALL AIR HANDLING EQUIPMENT(INCLUDING KITCHEN EXHAUST EQUIPMENT)
TOTAL SIZE OF SYSTEM(CFM) FRESH AIR INTAKE(CFM)
(PLANS MUST ACCOMPANY APPLICATION)
FURTHER DESCRIPTION OF WO
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN.BUILDING CODES IN THE
PERFORMANCE OF SUCH WO
:2-s- ,Z 4��, ,z
STATE LICENSE-NO. NAME&TYPE SIG ATURE F APPLICANT
PHONE NO�Ul ,f3� DATE
INSPECTOR JFP DATE � i TIME Oak
LOCATION
- f
INSPECTION: CODE: RESULT(D/A) :
BUILDING:
ELECTRICAL:
PLUMBING:
HVAC: 14(Ca
J
OTHER:
i-